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Table of Content

    09 October 2023, Volume 19 Issue 5 Previous Issue   
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    The lymphatic endothelial microchannel in the renal cortex of the rat

    MA Qiaoying, PAN Weiren, ZENG Fanqiang, et al
    2023, 19 (5):  435. 
    Abstract ( 71 )   PDF (2150KB) ( 56 )  
    Objective　To explore the endothelial microchannel and ultrastructure of the lymphatic vessel in the renal cortex
    of the rat. Methods　Twelve kidneys were obtained from six rats. Eight of them were examined by histological section, Haema
    toxylin Eosin (HE) and Immunohistochemical (IHC) staining. The other four were examined by scanning electron microscopy af
    ter tissues were pre-prepared. Results　Lymphatic vessels were hardly recognized in the HE staining section of the rat kidney,
    but could be detected by IHC staining of LYVE-1. They had irregular and thin walls with varying shapes and sizes. Some nuclei
    of the endothelial were protruded into the lumen. The scanning electron microscope showed that scattered entrances of the endo
    thelial microchannel were seen on the lymphatic vessel in the renal cortex of the rat, which contained a semicircular“roof”
    and a
    flat“floor”.
    Metabolites were scattered around or gathered at the entrance. Conclusion　This study introduces the morpholog
    ical structure of endothelial microchannels of the lymphatic vessel in the renal cortex of the rat. The result can provide a morpho
    logical theoretical basis of experimental animals for further basic scientific research, tissue engineering, 3D tissue printing, and
    clinical applications.
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    The application of pedicled vastus lateralis-myocutaneous flap in the repair of complex wounds in the lower limbs#br#
    LIU Jiayue, CHEN Yong, WANG Qian, et al
    2023, 19 (5):  440. 
    Abstract ( 67 )   PDF (2961KB) ( 80 )  
    Objective　To investigate the efficacy of pedicled vastus lateralis-myocutaneous flap in repairing complex
    wounds of the lower limbs. Methods　From Jan. 2016 to Dec. 2021, pedicled vastus lateralis-myocutaneous flap were used to
    repair complex wounds in the lower limbs in 9 cases, including 4 cases of anterograde flap and 5 cases of retrograde flap. The
    wounds were caused by traffic accident in 4 cases, burn in 1 case and the excision of malignant tumor in 4 cases. The defect
    ranged from 6.0 cm×4.0 cm to 20.0 cm×8.0 cm, and the harvested flaps ranged from 5.0 cm×5.0 cm to 23.0 cm×7.0 cm.
    The donor sites were sutured directly or repaired by skin-grafting. Results　All the flaps survived well and both the donor and
    recipient sites were primarily healed. After 3-12 months, the myocutaneous flap or muscle flap combined with skin-grafting had
    good texture, and the recovery of function was good. Cases with direct suture in donor area had good appearance, but cases with
    skin-grafting had poor appearance. Conclusion　The pedicled vastus lateralis-myocutaneous flap has large area, reliable blood
    supply and can be transferred flexibly. This flap is a good choice for repairing complex wounds in the thigh and upper legs.
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    Posterior tibial artery perforator flap assisted by DSA and Doppler ultrasound in the repair of skin and soft tissue defects in the lower leg

    SUN Yiran, CHEN Yong, WANG Qian, et al
    2023, 19 (5):  446. 
    Abstract ( 51 )   PDF (1533KB) ( 33 )  
    Objective　To explore the effect of using DSA and Doppler ultrasound to design posterior tibial artery perforator
    flap in the repair of soft tissue defect of the lower leg. Methods　From January 2020 to December 2022, 5 cases of lower leg
    soft tissue defects were treated with a cutaneous branch of the posterior tibial artery flap. Preoperatively, digital subtraction an
    giography (DSA) were used to confirm the course of the posterior tibial artery and the location of the penetrating branch, and the
    dominant perforating branch was selected. Doppler ultrasound confirmed the location of the dominant perforating branch, and
    the skin flap was designed based on the location and area of the wound, followed by skin flap transplantation. The donor flap area
    was covered with skin grafting. Results　DSA examination showed that among the 5 patients, 2 had no damage to the main blood
    vessels of the lower leg, and 3 had distal occlusion of the anterior tibial artery. All 5 patients showed perforating branches of the
    posterior tibial artery. Five cases of flaps and grafted skin sheets survived. After 6-12 months of follow-up, the appearance of the
    affected area was satisfactory, and the function of the leg and ankle joint recovered. Conclusion　Using DSA to observe the per
    forating branch of posterior tibial artery and select the dominant perforating branch, combined with Doppler ultrasound to guide
    the design of skin flap, good results can be obtained in the repair of the anterior and medial wounds of the lower leg.
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    Discussion on application and related issues of skin soft tissue expansion in treatment of congenital giant nevus

    WEI Siming, YAO Wende, WANG Na, et al
    2023, 19 (5):  450. 
    Abstract ( 75 )   PDF (1081KB) ( 34 )  
    Objective　To summarize the curative effect of congenital giant nevus after transcutaneous soft tissue expansion.
    Methods　In the past 9 years (July 2010 to September 2019), 28 patients with congenital giant nevus were treated and repaired
    by single/multiple one-stage expansion of head, trunk and limbs followed by two-stage flap repair. The expander was placed in
    stage I, and when the skin and soft tissue were fully expanded, the expander was removed, and the giant nevus on the head, face,
    trunk and limbs was removed. Skin flaps were designed according to the size and shape of the giant nevus to completely repair
    the defect. Results　In 28 cases, the area of giant nevus was about 13 cm×12 cm to 43 cm×33 cm, all of which were com
    pletely resected. One case of hematoma and three cases of infection were improved after active treatment, and the flap transfer
    was not affected. After follow-up for more than half a year, all the flaps survived well and no obvious contracture was observed.
    The color was similar to normal skin, and no recurrence was observed. Conclusion　Congenital giant nevus treated by skin soft
    tissue expansion is satisfactory and worthy of promotion.
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    Experience of laser treatment of finger contracture scars in children

    ZHOU Nian, YAO Zhigang, PU Yunjing, et al
    2023, 19 (5):  454. 
    Abstract ( 58 )   PDF (1665KB) ( 44 )  
    Objective　To explore the experience of laser treatment for finger contracture scars in children. Methods　A
    retrospective before-after self-control study was conducted. Thirty patients with finger contracture scars from December 2021
    to December 2022 were admitted. Among them, 17 cases of scars with red appearance and obvious congestion were treated with
    pulsed dye laser (PDL, 585 nm) combined with ultra pulse carbon dioxide lattice laser, while 13 cases of skin scars were treated
    with ultra pulse carbon dioxide lattice laser alone. Each patient was treated three times, with a 2-month interval between each
    treatment. Before and after treatment, the Vancouver Scar Scale (VSS) was used to score the scar condition, and the changes in
    the range of motion of the affected joint before and after treatment, as well as the occurrence of adverse reactions, were recorded.
    The efficacy was evaluated 8 weeks after the end of treatment. Results　After treatment, the VSS score of all cases decreased
    significantly compared to before treatment (P<0.05), the range of motion of the affected joint was significantly higher than before
    the first treatment (P<0.05). The efficacy evaluation results showed that there were 19 cases of significant improvement, 8 cases
    of effective treatment, and 3 cases of ineffective treatment, with a significant improvement rate of 63.3% and an effective rate of
    90.0%. No adverse reactions such as blisters, infections, or hypertrophic scar formation were observed in the treatment area after
    treatment. Conclusion　Laser treatment of finger contracture scar in children has obvious effect and less related complications,
    which is worthy of clinical promotion.
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    Application of multipoint injection indocyanine green lymphography in lymphaticovenular anastomosis of lower limbs

    ZHOU Xuchuan, LIU Bin, WANG Wenfei, et al
    2023, 19 (5):  459. 
    Abstract ( 80 )   PDF (1122KB) ( 126 )  
    Objective　To explore the application of multipoint injection indocyanine green (ICG) lymphography in lymphaticovenular anastomosis (LVA) of lower limbs and analyze the advantages of the improved lymphography. Methods　From
    December 2020 to June 2022, 57 patients with lower limb lymphedema were selected as the study subjects and were divided
    into the single injection group (n=25) and the multi-injection group (n=32). In the single injection group, ICG was injected into
    the first toe web. In the multi-point injection group, ICG was injected preoperatively at the first web, medial malleolus, lateral
    malleolus, medial knee and lateral knee. The linear pattern was observed by ICG lymphography and LVA was performed in both
    groups. The number of lymphatic vessels anastomosed and the time of surgery were compared. Lower extremity lymphedema
    index (LELI) was used as the prognostic index, the symptom relief of lymphedema half a year after LVA was evaluated in both
    groups. Results　The number of anastomotic lymphatic vessels in the multi-injection group was higher than that in the single
    injection group, and the surgery time was lower than that in the single injection group (P<0.05). The LELI of the multi-injection
    group and the single injection group half a year after LVA were lower than that before operation (P<0.05). The circumference of
    the affected limb was reduced in both groups after operation, the reduction of LELI in the multi-point injection group was higher than that in the single injection group (P<0.05). Conclusion　Multipoint injection indocyanine green lymphography can find more pattern before operation and shorten the time of looking for lymphatic vessels, which has high clinical application value.
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    Analysis of time window and influencing factors of various complications after breast reconstruction with prosthesis implantation

    GAO Qiang
    2023, 19 (5):  464. 
    Abstract ( 77 )   PDF (942KB) ( 44 )  
    Objective　To evaluate and analyze the time window and influencing factors of various complications in breast
    cancer (BC) patients undergoing implant-based breast reconstruction (IBBR). Methods　The retrospective study method was
    used in this study. Extract the data to be analyzed from the inpatient medical records. The onset time of complications after breast
    reconstruction in BC patients was described and summarized, and the related factors influencing the onset of complications were
    analyzed by COX. Results　There were 129 cases of acute and long-term complications in 395 cases of breast reconstruction
    surgery, and the incidence rate of complications was 32.66%. Among them, 73 patients (104 breasts) had at least one complication. Chemotherapy was the protective factor of postoperative hematoma (P<0.05). The indications of therapeutic mastectomy,
    tissue expander implantation, prosthesis implantation in the anterior plane of pectoral muscle, preoperative radiotherapy for
    IBBR, obesity and smoking were the risk factors for postoperative seroma (P<0.05). Preoperative radiation therapy was a risk
    factor for postoperative necrosis of nipple areola/skin flap in patients with IBBR (P<0.05). The indication of therapeutic mastectomy and axillary lymph node dissection were the risk factors for postoperative infection in the surgical area (P<0.05). Preoperative radiotherapy, obesity, axillary lymph node dissection, and reconstruction support material Vicryl mesh were the risk factors
    for prosthetic loss in patients with IBBR (P<0.05). Prosthesis implantation in the anterior plane of pectoral muscle, preoperative
    radiotherapy for IBBR, chemotherapy and obesity were the risk factors for postoperative ripple/wrinkle (P<0.05). Radiotherapy
    before IBBR and axillary lymph node dissection were the risk factors of capsular contracture (P<0.05). Conclusion　Postop
    erative complications of IBBR in BC patients show discrete time distribution. These findings have a certain value in guiding the
    postoperative treatment, follow-up and clinical trial design of patients.
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    Observation on the curative effect of stratified strategic operation for correction of lower eyelid retraction caused by lowering the lower eyelid

    NIE Lili, LU Hua, GUO Meili, et al
    2023, 19 (5):  471. 
    Abstract ( 51 )   PDF (1553KB) ( 40 )  
    Objective　To explore the curative effect of stratified strategic operation for correction of postoperative lower eyelid retraction in patients underwent lowering the lower eyelid. Methods　The original surgical approaches were traced in 16 cases (32 eyes) with lower eyelid retraction after lowering the lower eyelid: 3 cases (6 eyes) with transconjunctival approach, accounting for 18.7%; 9 cases ( 18 eyes) with transcutaneous approach, accounting for 56.3%; 4 cases with transconjunctival combined skin approach, accounting for 25.7%. According to the approach and clinical manifestations, the retraction of the anterior ,middle and posterior layers of the lower eyelid was preliminarily judged. The skin approach was used in all operations, removing
    the sutures in the middle and posterior layers. And adopting Hamra lower eyelid blepharoplasty with releasing arcuate margin
    and preserving orbital fat, to release scar contracture of orbital septum and orbital fat layer, and the middle and posterior elasticity and anatomical position were recovered. For the defects and deficiencies of the anterior layer, the suspension of orbicularis
    oculi muscle and the lifting of the midfacial skin were used to supplement. Results　All 16 cases (32 eyes) were followed up
    for 2-36 months, with an average of 13.1 months. All cases were significantly corrected and improved, and the satisfaction rate
    was 93.5%. Conclusion　For the mild to moderate lower eyelid retraction caused by lowering the lower eyelid, suture removal,
    release of scar adhesion and good reduction can be achieved, combined with Hamra lower blepharoplasty and orbicularis oculi
    muscle suspension, good correction results can be achieved.
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    Skin grafting combined with double eyelid plasty in repairing cicatricial upper eyelid ectropion

    LI Feng, JIANG Zhangjia, JIAO Xiangong, et al
    2023, 19 (5):  476. 
    Abstract ( 53 )   PDF (1354KB) ( 31 )  
    Objective　To explore the effect of free skin graft combined with double eyelid surgery in repairing cicatricial
    upper eyelid valgus. Methods　Since 2010, a total of 78 cases (146 eyes) of cicatricial upper eyelid valgus were repaired by
    free skin grafting combined with double eyelid surgery. Results　All the patients were followed up for 3-24 months. All skin
    grafts survived well, valgus was corrected, and the eyelid could close naturally. The cure rate was 89.74% for first operation and
    100% for reoperation. The double eyelid line of 135 eyes in 146 eyes was good, and the excellent rate of double eyelid formation
    was 92.47%, the effect was satisfactory. Conclusion　Skin grafting combined with double eyelid surgery in repairing cicatricial
    upper eyelid eversion is a more feasible surgical method, which has the dual effects of functional and aesthetic repair.
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    Application of IPACK (interspace between the popliteal artery and the capsule of the posterior knee blocks) combined with adductor canal block and sciatic nerve block combined with adductor canal block in analgesia after total

    knee arthroplasty in elderly people

    JIN Hao, FU Qiang
    2023, 19 (5):  480. 
    Abstract ( 64 )   PDF (917KB) ( 55 )  
    Objective　To investigate the effect of ultrasound-guided interspace between popliteal artery and capsule of the
    posterior knee (IPACK) blocks combined with adductor canal block and sciatic nerve block combined with adductor canal block
    in elderly patients undergoing total knee arthroplasty (TKA). Methods　This study was a prospective study. The clinical data
    of 108 elderly patients undergoing unilateral TKA were included. The patients were randomly divided into two groups: the observation group received IPACK combined with adductor canal block, the control group received sciatic nerve block combined
    with adductor canal block, with 54 cases in each group. Outcome measures including: Changes of vital signs, recovery time,
    incidence of related adverse reactions; Expression levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), matrix metalloproteinase 3 (MMP3), high sensitivity C-reactive protein (hs-CRP) at 6, 12, 24 h after operation; Numerical rating scale (NRS)
    pain score and substance P (SP) at 6, 12, 24 h after operation; Lysholm score and WOMAC score at 48 h after operation were 
    compared. Results　The changes of vital signs in the two groups were compared, the systolic blood pressure (SBP), diastolic
    blood pressure (DBP) and heart rate (HR) in the observation group were lower than those in the control group (P<0.05); The
    recovery time, recovery time of postoperative spontaneous respiration, and PACU stay time of the observation group were
    shorter than those of the control group (P<0.05); The incidence of adverse reactions including nausea, vomiting and hypoxemia
    in the observation group were lower than those in the control group (P<0.05); The levels of IL-6, IL-1β, MMP3 and hs-CRP
    in the observation group at 6, 12, 24 h after operation were lower than those in the control group (P<0.05); The resting and
    exercise NRS pain scores and substance P in the observation group were significantly lower than those in the control group
    (P<0.05); The Lysholm scores in the observation group at 48 h after operation were higher than those in the control group,
    but the WOMAC scores in the observation group at 48 h after operation were lower than those in the control group (P<0.05).
    Conclusion　IPACK combined with adductor canal block for elderly patients undergoing TKA surgery has a good analgesic
    effect, it can help the patients to reduce their recovery time, maintain the stability of hemodynamics, alleviate inflammatory
    response, improve the pain control and reduce the occurrence of adverse reaction, which is better than the sciatic nerve block
    combined with adductor canal block.
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    A training system based on the core professional competence of specialized nurses of Plastic and Reconstructive Surgery

    YANG Jiafei, BIAN Weiwei, HUANG Yin
    2023, 19 (5):  487. 
    Abstract ( 57 )   PDF (852KB) ( 82 )  
    Objective　To investigate a training system based on the core professional competence of specialized nurses of
    Plastic and Reconstructive Surgery. Methods　Thirty-two nurses in the Plastic and Reconstructive Surgery ward were selected
    by convenience sampling method from March 2021 to August 2021, and were divided into control group and experimental group,
    with 16 nurses in each group. Nurses in the experimental group were trained based on the morality, theoretical knowledge, professional abilities, practical abilities, and developmental capabilities, while nurses in the control group were just trained in a traditional way. Those in experimental group underwent leveled training, leveled teaching, practical teaching, and problem-based
    learning (PBL) in a process of 6-month training project. After training, both groups were evaluated in professional knowledge,
    operations, specialized nursing quality, and patient satisfaction survey. An assessment of teaching experience was conducted
    in the experimental group. Results　The scores of professional knowledge, operations, specialized nursing quality, and patient
    satisfaction survey in experimental group were significantly higher than those in the control group (P<0.05). Moreover, the evaluation of teaching experience in experimental group showed that the nurse training system based on core professional competence
    was beneficial to improve the core competence of specialized nurses in Plastic and Reconstructive Surgery ward. Conclusion
    The training of specialized nurses in Plastic and Reconstructive Surgery ward based on core professional competence is helpful to
    improve the comprehensive quality and teaching experience of nursing staff, improve nursing quality and inpatients’ satisfaction with nursing servi
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    Effect of fasting time on postoperative rehabilitation of elderly patients in perioperative rapid rehabilitation integrated management system of hip and knee arthroplasty #br#

    Effect of fasting time on postoperative rehabilitation of elderly patients in perioperative rapid rehabilitation

    integrated management system of hip and knee arthroplasty

    YANG Yinlin, CUI Yaping
    2023, 19 (5):  492. 
    Abstract ( 61 )   PDF (839KB) ( 25 )  
    Objective　To explore the effect of preoperative fasting time on postoperative rehabilitation of elderly patients in
    perioperative rapid recovery comprehensive management system of hip and knee replacement. Methods　According to different
    preoperative fasting time management methods, elderly patients (>80 years old) who underwent hip and knee replacement from
    July 2018 to June 2021 were randomly divided into control group and fast recovery group. A total of 380 patients in the control
    group were given the control fasting program, and 380 patients in the fast recovery group were given the personalized fasting program according to the fast recovery concept and refined nursing process, basically referring to no clear fluid 2 hours before operation, no semi-fluid 4 hours before operation, and no solid diet 6 hours before operation. The actual fasting time, the proportion
    of patients requiring fluid rehydration before operation, the incidence of aspiration, the incidence of postoperative gastrointestinal
    symptoms such as nausea and vomiting, the postoperative ground time, the postoperative hospital stay and the joint function score
    during follow-up were compared between the two groups. Results　The fasting time of the control group was significantly longer
    than that of the fast recovery group. The proportion of patients requiring fluid rehydration before operation in control group was
    significantly higher than that in fast recovery group. There was no intraoperative and postoperative aspiration in the two groups.
    The incidence of postoperative nausea and vomiting in control group was significantly higher than that in fast recovery group. The
    postoperative ground time in the control group was significantly longer than that in the fast recovery group. The average length
    of postoperative hospital stay in the control group was higher than that in the fast recovery group, but there was no statistical
    significance. There was no significant difference in joint function score between the control group and the fast recovery group at
    6 weeks after operation. Conclusion　Using the concept of fast recovery and fine nursing, personalized setting of fasting time
    before hip and knee replacement can significantly reduce the incidence of postoperative gastrointestinal discomfort, improve the
    short-term recovery speed, shorten the postoperative hospital stay, but has no significant effect on the joint function of patients 6
    weeks and more after surgery.
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    Research progress of marine derived natural active substances used in bone tissue engineering

    ZHAO Qihang, GUO Qingyuan, LYU Najun
    2023, 19 (5):  496. 
    Abstract ( 58 )   PDF (874KB) ( 107 )  
    　There are many bioactive substances in the ocean, and about 80% of the biological resources on the earth exist in
    the ocean. It has great potential to develop drugs and materials from the ocean. Marine active substances mainly include biological information substances, physiological active substances, marine biotoxins and biological functional materials. In this paper,
    research progress of marine active substances with research and development prospect in the field of bone tissue engineering was
    briefly introduced.
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    Application and progress of chest wall reconstruction materials

    WANG Zhanlei, JIN Jian
    2023, 19 (5):  502. 
    Abstract ( 51 )   PDF (824KB) ( 66 )  
    Chest wall reconstruction is a common method to repair the damaged chest wall structure and restore the normal
    function of the chest wall after thoracic surgery. At present, autologous skin flaps have become an ideal material for chest wall
    soft tissue reconstruction, but there is still much controversy about the choice of chest wall skeleton reconstruction materials. In
    addition to autologous bone, non-degradable material is a kind of chest wall reconstruction material with many clinical applications, which has good tissue strength and stability, and has fewer complications. At the same time, with the continuous deepening
    of the research on chest wall reconstruction materials, biodegradable materials have become a new hot spot in clinical application
    experiments and research on the improvement of the properties of chest wall reconstruction materials. Among them, 3D printed
    absorbable materials have high clinical feasibility. Based on this, the application status and progress of chest wall reconstruction
    materials were reviewed in this paper.
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    Research progress in the treatment of hypertrophic port-wine stain

    GAO Qianqian, LI Yangqun
    2023, 19 (5):  507. 
    Abstract ( 63 )   PDF (821KB) ( 52 )  
    　Port-wine stain (PWS) is a congenital, progressive capillary malformation that does not recede spontaneously.
    The incidence of PWS in the newborn is about 0.3% to 0.5%. The early clinical manifestations are pink spots or plaques, which
    are more common on the face. With age, the color of the lesions deepens. Also, most patients will develop hypertrophy during
    their adult life, which increases the difficulty of treatment, and adversely influence patients’ psychology and quality of life. The treatment of hypertrophic PWS was reviewed in this paper.
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    Research progress of the effect of radiotherapy on breast reconstruction with prosthesis and autologous tissue after breast cancer surgery

    REN Yanxin, YU Yan, XU Kexin, et al
    2023, 19 (5):  511. 
    Abstract ( 90 )   PDF (903KB) ( 167 )  
    　Breast integrity and beauty affect women’s physical and mental health. Immediate breast reconstruction after
    breast cancer mastectomy can significantly increase women’s self-confidence and improve women’s quality of life. As a conventional treatment for breast cancer, radiotherapy can reduce the local recurrence rate and disease-free survival rate of breast cancer. However, radiotherapy can increase the complication rate and failure rate of breast reconstruction immediately after breast
    cancer surgery. The two most commonly performed breast reconstruction procedures are breast reconstruction with autologous
    tissue and breast reconstruction with prosthesis. In this paper, the effects of radiotherapy on autologous tissue breast reconstruction and prosthesis breast reconstruction were reviewed.
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    Evaluation of facial injection filling materials for medical aesthetics

    ZHAO Chenyu, LI Chongchong, SUN Xue, et al
    2023, 19 (5):  517. 
    Abstract ( 176 )   PDF (874KB) ( 874 )  
    With economic development and technological progress, the demand for medical aesthetics has increased sig
    nificantly, and medical biomaterials are widely used. It is necessary to further improve the evaluation of their effectiveness and
    safety. At present, the evaluation of its physicochemical properties and biology is adopted in China. However, the clinical effec
    tiveness is a multi-faceted evaluation without unified criteria. Most of the evaluation mainly adopts objective indicators for quan
    titative analysis, while subjective feelings are secondary criteria. In this paper, the main facial fillers and the evaluation methods
    of their physicochemical properties were reviewed.
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